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HomeMy WebLinkAbout25-4613 j ITFC II IIIII III IIIII II IIII IIIII I . 27I OOLCERAF EF96906 COLLISION REPRT 1591971 CASE# 25-4613 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL NENO'Y. 4200 3 COUNTY RD INVOLVED CODING PRIVATE WAY 2❑ TRIBAL TOTAL 1 UNITS#OF 02 SO BJECT TRUCK 1 8 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulsloN' 05 - 27 - 2025 0834 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION MAPLE VALLEY HIGHWAY MILE POST e 2000 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------�.� FEET e S B W 2 0 29 MOTtlR PEDAL- DAMAG THRESHOLD MET PHON UNIT 01 E VEHICLE ❑ CYCLE ❑ YES No �/ D:4255124566 0 1 30 6 LAST NAME MACDONALD FIRST NAME JAMES MIDDLE F 1 1 2 31 INITIAL STREET ❑ 3329 99TH PL SE CITY EVERETT ST WA ZIP 982084378 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCKYEs NC INTERLOCK YEs Na YES D NO 8❑ LICIENS# STATE WA SEX M MMOCSYY' 08 - 02 - 1983 1 2 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY CLASS 1 NAruRE of INJURIES 2 LICENSE, CLP3156 STATE WA VIN# 1GBFG15R4X1007822 3 10[9� PI ATP tt 11[-j- TRAILER STATE TRAILER ,STATE ROM TO 11 3 5 PLATE# PLATE# TRLR TRLR 3 7 33 12 3 5 VIN# vI. ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 13 4 1999 CHEV EXPRES DAMAGE YES DNO ✓ YEs No 3 7 34 REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 LIABILITY INSURANCE 14 ❑ NSURANCECO IN EFFECT &POLICY# i STOP ❑ _ S L `LE CHARGE 10 BOTTOM 36 r Ly YES❑NO❑ CITATION# 5A0512646,5AO512646 IMPROPER LANE USAGE,OP MOT 15 sn c B 7 a III MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT Q2 VEHICLE CYCLE nWNFR YES�/ NO D:2069736866 16� LAST NAME LAO FIRST NAME NAIM MIDDLE' INITIAL 17 F1 STREET ❑'❑ 15926 SE 177TH ST CITY RENTON ST, W 37 q ZIP 980589115 NEW ADDRESS 1g❑ CDL IGNITION REQUIRED fGNfTION PRESENT MEDIGALTRANSP(SRTED' 38 INTERLOCKYES No INTERLOC(XYES 0No YEs No' 19 DRIVER'S STATE WA SEXI M D•©•B. 11 07 1987 39 LICENSE# MMDLSYY — HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSECAS6516 TATE WA VIN# 5YJ3E1EC1MF073635 � 41 PLATE# 22❑ PLATE# STATE PAAILER TE# STATE ❑ 42 23 TRLR kRUR 43 UIN#. 'IN#. VEH.YEAR 2Q21 MAKE TESL MODEL MODEL 3 STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO�/ YES NO�/ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCECO STATE FARM 5020451-DO5.47A IN EFFECT &POLICY# t 9TOP vewaE ❑ ,.I—I CITATION# i060TTOM EEGnEEv YES N CHARGE 6 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 C.ARNOLD 12509 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EF96906 COLLISION REPORT III III III III III 111 1591972 CASE# 25-4613 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INTTIAL) ADDRESS&PHONE# SEX' D.O.B. - [----------� MMDDYYYY PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--� POS. USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. - L----------� MMDDYYYY PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. - L----------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----j NARRATIVE Please see subsequent narrative pages I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.ARNOLD 05-27-25 10:35 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 6/2/2025 8:05:27 AM BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 9:39 AM TIME POLICE ARRIVED 9:44 AM PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47 EAN REPORT No.` EF96906 CASE# 25-4613 O OF COLLI COLLISION TIME 05/27/25 09:34 COLLI NARRATIVE CC 25-4613 On 5/27/2025 at 0939 hours I was dispatched to a motor vehicle collision at around the 2000 block of Maple Valley Highway in the City of Renton, King County, Washington. Pre-Collision Driver 2 stated that he was traveling West on Maple Valley Highway at around the 2000 block and had just merged from the #2 lane into the #1 lane. Driver 2 stated that he was going straight ahead. Driver 1 stated that he was traveling West on Maple Valley Highway in the #2 lane and was preparing to merge right from the #2 lane into the #1 lane. Collision Driver 2 stated that as he was traveling straight ahead, Unit 1 merged into his lane and he did not have time to slow or move to avoid a collision. Driver 1 stated that the front drivers side bumper and drivers side mirror of Unit 2 collided with the rear passenger side door and rear passenger side quarter panel of Unit 1. Driver 1 stated that Unit 2 had just merged into lane #1 as he was merging into lane #1 from lane #2. Driver 1 stated that as he merged into lane #1, the front drivers side bumper of Unit 2 collided with the rear passenger side door and quarter panel of Unit 1. Driver 1 stated that he did not have insurance on Unit 1 at the time of collision. Injuries No injuries reported Vehicle Disposition Both vehicles were operational. Proximate Cause I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as nearly as practicable entirely within a single lane and shall not be moved from such lane until the driver has first ascertained that such movement can be made with safety. Driver 1 was cited per RCW 46.61.140 and RCW 46.30.020. 1 certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer C. Arnold #12509 at 10:24 on 5/27/2025 in the City of Renton, King County, Washington. PAGE 3 OF 4 REPORT NO. EF96906 CASE# 25-4613 DATE AND TIME i 05/27/25 09:34 OF COLLISION { l Y t fl. t PAGE 4 OF 4